Abstract
Endoscopic submucosal dissection (ESD) allows en-bloc resection of superficial gastrointestinal tumors, providing specimens on which lateral margin analysis can be performed reliably. Positive lateral margins have been linked to higher rates of recurrence/residual tumor. There are no guidelines for macroscopic processing of lateral margins. Currently, most institutions use parallel lateral sections, which are difficult to interpret. We use perpendicular lateral sections, hypothesizing that it decreases potential artifactually positive lateral margins. We analyzed positive lateral margin rates in colorectal ESD specimens according to sectioning method. We also looked at morphological factors associated with margin positivity as a function of technique used. We studied 166 ESD specimens, on which parallel sectioning practiced from 2006 to 2011 (n = 75). Perpendicular sectioning was used from 2010 to 2015 (n = 91). We recorded the number of positive margins, along with grade of dysplasia/carcinoma. Other information such as histopathological type, specimen size, lesion location, and patient follow-up was also recorded for evaluation. Forty of seventy-five (63%) margins were positive for parallel sections. In contrast, perpendicularly cut margins were significantly less frequently positive: 22/91 (24%) (p = 0.0001). Positive margins were found significantly more frequently in tubulo-villous lesions compared to tubular lesions in both the parallel and perpendicular groups (p = 0.03 and p = 0.02, respectively). Specimen size was not significantly associated with positive margins. Using perpendicular sectioning of colorectal ESD specimens, the proportion of cases with a positive lateral margin was significantly lower than when parallel sectioning was used. We suggest perpendicular sectioning to improve accuracy in histopathological analysis. This method is particularly important to use in future studies, as it may prevent authors from making conjectures based on overestimation of positive lateral margins.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fujiya M et al. (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 583–95
Lauwers GY et al (2004) Endoscopic mucosal resection for gastric epithelial neoplasms: a study of 39 cases with emphasis on the evaluation of specimens and recommendations for optimal pathologic analysis. Mod Pathol 17(1):2–8
Ono H et al (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48(2):225–229
Fu Q et al. (2016) Relevant risk factors of positive lateral margin after en bloc endoscopic submucosal dissection for early gastric adenocarcinoma. J Dig Dis.
Buchholz TA et al (2014) Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol 32(14):1502–1506
Nagata K, Shimizu M (2012) Pathological evaluation of gastrointestinal endoscopic submucosal dissection materials based on Japanese guidelines. World J Gastrointest Endosc 4(11):489–499
Wright MJ et al (2007) Perpendicular inked versus tangential shaved margins in breast-conserving surgery: does the method matter? J Am Coll Surg 204(4):541–549
Chevaux JB et al (2015) Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett’s neoplasia. Endoscopy 47(2):103–112
Lambert R et al (2009) Pragmatic classification of superficial neoplastic colorectal lesions. Gastrointest Endosc 70(6):1182–1199
(2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 58(6 Suppl):S3–43
Harris PA et al (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381
Ueno H et al (2004) Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology 127(2):385–394
Pohl H et al (2013) Incomplete polyp resection during colonoscopy—results of the complete adenoma resection (CARE) study. Gastroenterology 144(1):74–80 e1
Kim TK et al (2015) Risk factors for local recurrence in patients with positive lateral resection margins after endoscopic submucosal dissection for early gastric cancer. Surg Endosc 29(10):2891–2898
Dolak W et al (2015) A pilot study of the endomicroscopic assessment of tumor extension in Barrett’s esophagus-associated neoplasia before endoscopic resection. Endosc Int Open 3(1):E19–E28
Lee JH et al (2015) Clinicopathological factors of multiple lateral margin involvement after endoscopic submucosal dissection for early gastric cancer. Surg Endosc 29(12):3460–3468
Ishii T et al (2011) Tubular adenomas with minor villous changes show molecular features characteristic of tubulovillous adenomas. Am J Surg Pathol 35(2):212–220
Yasuda K et al (1997) Morphogenesis and development of superficial spreading tumor of the colon and rectum. Pathol Int 47(11):769–774
Hassan C et al (2013) Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 45(10):842–851
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
As the resection of these superficial colorectal lesions is an indicated therapeutic act that is solely to the benefit of the patient, informed consent of the patient is not required, according to the Belgian law of December 19, 2008 (Chapter III, Article 9).
Rights and permissions
About this article
Cite this article
Dessain, A., Snauwaert, C., Baldin, P. et al. Endoscopic submucosal dissection specimens in early colorectal cancer: lateral margins, macroscopic techniques, and possible pitfalls. Virchows Arch 470, 165–174 (2017). https://doi.org/10.1007/s00428-016-2055-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00428-016-2055-1